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Psychology /Psychotherapy: 117b - Antidepressants

Psychotherapy: 117b - Antidepressants

Psychology26 CardsCreated 6 months ago

This flashcard set covers the use of SNRIs and TCAs in managing chronic pain, with TCAs (notably amitriptyline) being especially effective for migraines. It also reviews key amino acid precursors: tryptophan for serotonin and tyrosine for dopamine and norepinephrine.

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Which classes of antidepressants are useful in the treatment of chronic pain?

SNRIs

TCAs

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Key Terms

Term

Definition

Which classes of antidepressants are useful in the treatment of chronic pain?

SNRIs

TCAs

Which class of antidepressants is especially useful for treating migraine?

TCAs

(Especially amitryptiline)

Which amino acid is a precursor for serotonin?

Tryptophan

Tyrosine is a precursor for which neurotransmitters?

Dopamine, NE

(Dopamine is a precursor for NE)

List 3 common features of all classes of antidepressants

Takes 3-8 weeks to be maximally effective
All have equivalant response and remission rates
- 50-70% response...

If a patient experiences partial improvement at the maximally tolderated dose of antidepressant A, what is the next step in their management?

Add another antidepressant of a different class

OR

Tar...

How should you select a first-line antidepressant?

(What factors should influence your decision?)

Side effect profile
Past response

Which classes of antidepressants are first line for treating depression?

SSRI
SNRI
Mirtazapine

List 3 serious risks of antidepressant treatment

Increased risk of suicidal thinking, behavior in young people
- Highest in the first few days on the medication

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Psychotherapy: 117b - Antidepressants

Term	Definition
Which classes of antidepressants are useful in the treatment of chronic pain?	SNRIs TCAs
Which class of antidepressants is especially useful for treating migraine?	TCAs (Especially amitryptiline)
Which amino acid is a precursor for serotonin?	Tryptophan
Tyrosine is a precursor for which neurotransmitters?	Dopamine, NE (Dopamine is a precursor for NE)
List 3 common features of all classes of antidepressants	Takes 3-8 weeks to be maximally effective All have equivalant response and remission rates 50-70% response 35-50% remission Placebo-drug differences depend on the level of severity of depression More severe depression = less placebo effect
If a patient experiences partial improvement at the maximally tolderated dose of antidepressant A, what is the next step in their management?	Add another antidepressant of a different class OR Target residual symptoms with other treatments Remeber: The goal of treatment is complete response
How should you select a first-line antidepressant? (What factors should influence your decision?)	Side effect profile Past response Comorbid medical and psichiatric problems Remember: no significant differences in efficacy among first line medications Consider psychotherapy in addition
Which classes of antidepressants are first line for treating depression?	SSRI SNRI Mirtazapine Bupropion Select agent based on side-effect profile All have comparable efficacy TCAs and MAOIs are not first line due to higher side effect burden, potential for lethal overdose
What are the 6 most common side effects of SSRIs and SNRIs? Which ones usually improve?	GI upset Anxiety, agitation Insomnia Headache Sweating Sexual dysfunction All except sexual dysfunction usually improve
List 3 serious risks of antidepressant treatment	Increased risk of suicidal thinking, behavior in young people Highest in the first few days on the medication Risk of treatment < risk of untreated depression Serotonin syndrome Do not give antidepressant monotherapy for anyone with bipolar disorder Increases manic episodes
What is serotonin syndrome? How can it be avoided?	Result of increased 5HT activity in the brain, usually from multiple serotoninergic drugs Mental status change Hyperthermia Hyperreflexivity Never combine MAOIs with TCAs or SSRIs
Which SSRI has the longest half life? Why is this important?	Fluoxetine No need to taper Requires long wash-out if transitioning to MAOI
Which SSRI has the highest risk of drug-drug interactions? Why?	Paroxetine It is a potent CYP26 inhibitor
Which SSRI has the shortest half life? Why is this important?	Paroxetine Results in the worst discontinuation symptoms (must taper)
Which SSRI should be avoided in anyone with cardiac comorbidities?	Citalopram Dose-depenent QT prolongation
Which SSRI is preferred in pregnancy?	Sertraline
What is the most common side effect of the SNRIs?	Hypertension (In addition to the side effects common to all agents that increase 5HT and NE: GI upset, weight gain, sweating, sexual dysfunction)
What is the mechanism of action of TCAs?	Inhibit NE and 5HT reuptake
What are the common side effects of TCAs?	Sedation Weight gain Orthostatic hypotension Arrhythmia (may be fatal) Seizure Sexual dysfunction Anticholinergic effects Dry mouth, urinary retention, constipation
What special diet must be followed when a patient is on a MAOI? What happens if they do not follow this diet?	Tyramine free diet: No aged cheese, red wine, fava beans, cured meats Can cause hypertensive crisis if ingested while on MAOI
Which antidepressant should you prescribe to a patient that does not have anxiety symptoms and want to experience weight gain or sexual dysfunction?	Buproprion May worsening existing anxiety symptoms (Mirtazapine does not have sexual side effects, but can cause weight gain)
Which antidepressants carry the lowest risk of switch to mania if there is undiagnosed bipolar disorder?	Bupropion Mirtazapine
What are the mechanisms of action of mirtazapine?	Alpha-2 block Increased NE and 5HT release Blocks 5HT-2 and 5HT-3 receptors H1 block
Which antidepressant is often used elderly patients with insomnia and low appetite?	Mirtazapine Side effects of sedation and weight gain may be helpful!
What is the mechanism of trazodone?	5HT-2 receptor block Alpha-1 block Histamine block (Not great for depression, effective for insomnia)
Which antidepressant has the potential side effect of priapism?	Trazodone